Mr Vaughan Tanner BSc MBBS FRCOphth Consultant Ophthalmic Surgeon

Transcription

1 Mr Vaughan Tanner BSc MBBS FRCOphth Consultant Ophthalmic Surgeon Spire Dunedin Hospital 22 Bath Road Reading RG1 6NS Circle Hospital 100 Drake Way Reading RG2 0NE The London Clinic 119 Harley Street London W1G 6AU Princess Margaret Hospital Osborne Road Windsor SL4 3SJ Tel: / Fax: / Reading@tanner-eyes.co.uk Windsor@tanner-eyes.co.uk The intended benefits of the operation Micro-Incision Cataract Surgery Patient Information leaflet and Consent Form The main aim of the cataract operation is to improve the quality of your vision. It may also be of benefit to improve the view of the back of your eye. Mr Tanner, will try to reduce your dependence on spectacles as much as possible, but you may require distance glasses for best vision and you will probably need reading glasses dependent on the type of intraocular lens you choose. It is usually the case that your glasses prescription will change after the operation. You should be aware that even with the most modern preoperative measuring and surgical techniques, it is only possible to remove the requirement for distance spectacles altogether in up to 90% of people. The ultrasound (phacoemulsification) method of cataract removal is the gold standard for cataract surgery and has been demonstrated in several recent scientific publications to be safer than the laser method. Pre-operative and discharge information for patients Upon arrival in the hospital, the Day Case Unit staff will place dilating drops or a pellet just inside your lower lid. The drops will make your vision blurred but this enables Mr Tanner to have a good view of your cataract during the surgery. When you come to the Theatre, a local anaesthetic will be administered to make the operation painless. Some patients have anaesthetic drops (topical anaesthesia) and some will have an injection around the eye (sub-tenons anaesthetic). Although you may see light and movement during your operation, you will not be able to see the surgery, and do not have to worry about keeping your eye open or closed. The other eye will be covered up. The skin around your eye will be cleaned, and sterile coverings will be placed around your head. The operation usually takes about twenty minutes, sometimes a little longer. General Anaesthesia is also available for patients who are particularly nervous or unable to lie still. The cataract is removed using ultrasound energy. Mr Tanner has introduced new techniques to allow the surgery to take place through an incision of only approximately 2mm in length. This micro-incision technique is not only safer during the procedure but also helps ensure a rapid pain free recovery in most cases. Immediately after surgery When the operation is complete, a clear plastic shield and sometimes a pad will be placed over your eye. This is just to protect your eye for 2-3 hours while most of the anaesthetic wears off you do not have to wear it longer than that. However, some patients like the reassurance of covering the eye with a shield for a few days and nights post-operatively. The local anaesthetic takes up to 24 hours to fully wear off. You may notice at first that your eyelid is droopy or even closed this is normal, and recovers promptly. Double vision during this waking up process is also very common and recovers. Micro-incision Cataract Surgery Vitreo-Retinal Surgery Diabetic Retinopathy Glaucoma General Ophthalmology Age-Related Macular Degeneration

2 After a short stay back on the Day Case Unit you will be ready to leave. You should plan to have someone drive you home or take a taxi. The days after surgery The following day, you should have some vision, although usually quite blurry to start with. This should improve within hours. It is normal for the eye to be a little inflamed, gritty, and watery after surgery. You should aim to have a restful couple of days. You can drive when you feel comfortable and confident, and when you are able to read a car number plate at 20 metres (about three car lengths). You can bend down to pick things up, and after 24 hours you may wash your hair, obviously being careful not to get any shampoo in your eye. Please avoid mascara for the first week, or any other products that may cause pressure on the eye. After the first week, you may apply products around the eye carefully. You will normally be seen for a follow up appointment 1-3 weeks after your operation and second eye surgery discussed if appropriate. Usually, 4-5 weeks after surgery, you are asked to visit your Optometrist for spectacle testing and dispensing. The delay is so the eye can settle fully, and to allow time for subtle changes in corneal shape (and therefore spectacle requirement) to occur. The main need will usually be for reading glasses. A small distance correction (perhaps for driving) is sometimes necessary and some people like to have intermediate spectacles for computer use. Whilst waiting to see your Optician you may find it helpful to try a pair of off the shelf readers. Following surgery you will need to: Use the eye drops as prescribed and be careful not to rub or press on your eye Use over-the-counter pain medicine if necessary occasional paracetamol is usually sufficient Avoid jogging, golf, swimming and high impact exercise for one week. Continue normal daily activities and light exercise Report any significant pain or deterioration of vision What if I have a problem? If you experience significant eye pain or loss of vision: Please contact Mr Tanner s team on or Out of hours, please contact Hospital where you had surgery and they will contact Mr Tanner or his team. Main Hospital Switchboards are: Princess Margaret Hospital, Windsor Spire Dunedin Hospital, Reading Circle Hospital, Reading Berkshire Independent Hospital, Reading Eye Casualty at Royal Berkshire Hospital, Reading There is also a 24 hour ophthalmology emergency service at the Royal Berkshire hospital which can be accessed via your General Practitioner or the Main Accident and Emergency Department at The Royal Berks.

3 Additional Information - Premium Intraocular Lenses In some cases Mr Tanner will discuss your suitability for a premium intraocular lens rather than the standard distance monofocal lens. The premium lenses fall into two main categories - toric intraocular lenses and multifocal intraocular lenses. The aim of these lenses is to reduce spectacle requirement, However, you should be aware that is not achieved in every case and it would be unrealistic to expect to never wear glasses again for any activity after surgery Toric Intraocular Lenses These lenses are designed to decrease astigmatism in the eye and compensate for an irregular or rugby ball/oval shaped cornea. Use of the toric intraocular lens usually improves your visual quality and Mr Tanner generally recommends the lens in anybody with more than 1 dioptre of astigmatism. Toric lenses decrease your spectacle requirement for distance and help with the quality of vision achievable through varifocal or reading glasses. As with any lenses it is possible that the measurements and assumptions made with regard to the shape of your eye leave a residual refractive error which you may still have to correct with spectacles. In approximately 5% of cases, further surgery may be required to reposition the lens implant and achieve best results in those patients particularly motivated to decrease spectacle use. Further surgery may not be covered by standard medical insurance policies or the self-pay cost of the toric lens itself. If additional surgery is required and is not covered by your insurance policy it is approximately 2,000. Multifocal Lenses These lenses are designed to reduce your requirement for glasses for intermediate and/or near work. They come in various styles and the technology is evolving continuously. All multifocal-style lenses work by splitting light energy into a distance, intermediate and near focus point. These lenses have the advantage of decreasing but not entirely eliminating your need for intermediate/near glasses. The downside is that all of the designs carry a risk of glare and halo around bright lights at night which can be troublesome when driving. Up to 20% of people find the glare and other phenomenon irritating either during night driving or other activities dependent on exact lens design. However, over 90% of people are still happy with this procedure and accept the risk of side effects in return for increased ability to see intermediate or near work with minimal use of glasses. Some people also feel that the quality of vision obtained through a multifocal lens is not quite as clear as with a standard monofocal lens. These multifocal lenses tend to work best when inserted in both eyes. Mr Tanner usually recommends an intermediate multifocal lens as this offers a good opportunity to reduce spectacle use for most activities while avoiding the side effects associated with stronger/near multifocal lenses. Again variations in intraocular lens calculation and measurement mean that some residual refractive error and glasses requirement may be necessary in certain cases. Approx 5-10% of patients who are very motivated to become spectacle free may elect to have additional laser refractive surgery on the cornea to fine-tune the final spectacle prescription. This type of secondary enhancement is not covered by any of the standard self-pay or insurance packages. If secondary refractive enhancement is required, you can anticipate that it will cost approximately 2,500. Of course cataract surgery using any type of intra-ocular lens can potentially result in complications. One of the commoner complications includes capsular bag rupture. The more advanced premium intra-ocular lenses are all designed to sit within the capsular bag. Should you be unfortunate and develop a capsular bag complication during the procedure, then it will not be possible to insert a premium intraocular lens. In this scenario Mr Tanner would usually insert a standard distance dominant monofocal lens, aiming to give you good distance vision but accepting that premium lens implantation was not possible in your case. I do hope you find the above information helpful in addition to the other information you have received prior to your surgery. If you have any further questions please do not hesitate to contact me or my team.

4 Serious or frequently occurring risks during the operation If you decide against a cataract operation, your vision will probably slowly worsen. However, it is possible for a cataract operation to leave your vision worse than it is now. One person in every 1000 will go blind in that eye as a direct result of the operation. One in 10,000 will lose the eye. Details on some of the most common complications are given below. Bruising of eye or eyelids (quite common). Eyelid drooping common and temporary, very rarely needs further surgery. Posterior capsule rupture and / or vitreous loss - a split in the thin back wall of the cataract, which can allow communication between front and back compartments of the eye. 1:100 Dropped nucleus - part or all of the cataract falls through a posterior capsule rupture into the back part of the eye, needing another operation to remove it. Suprachoroidal haemorrhage - bleeding inside the eye. Post-operative raised intraocular pressure - raised pressure in the eye for the first day or so in the eye (common). Cystoid macular oedema - inflammatory fluid in the centre of the retina. Allergy - to drops given after the operation, causing an itchy swollen eye. Corneal decompensation - clouding of the clear front window of the eye may require corneal graft. Detached retina may require additional retinal surgery. Endophthalmitis - severe (usually painful) infection inside the eye. 1:1000 Sympathetic endophthalmitis - a very rare condition in which surgery in one eye triggers inflammation and sight problems in the other (1:10,000) Lens edge effect - some patients notice the edge of the intraocular lens when the pupil is dilated at night. The semi-circular line in the far peripheral vision usually fades with time and no action is required. Refractive surprise unexpected need for glasses. Occasionally glasses are not sufficient to correct refractive surprise and further surgery may be required. Dislocation of the implant movement out of position of the lens implant. Posterior capsular opacification - clouding of the membrane behind implant causing blurred vision. Common This may require a YAG Laser Capsulotomy to clear the visual axis, a simple outpatient procedure. Commoner if young, highly short-sighted or having multifocal lens inserted. Insurance companies understand that capsular thickening is frequently treated by laser after cataract surgery and will usually cover the cost of this procedure. Those on a self-pay package should be aware that the procedure is separate to their cataract procedure and does not fall within the self-pay package offered by the Private hospitals. The self-pay cost of a YAG laser Capsulotomy, if required is approx Although the above list may seem daunting, serious sight threatening complications are rare and in most cases can be treated effectively. In a small proportion of cases, a further operation may be required. Please read this form carefully. If you have any further questions, please ask - we are here to help you. You have the right to change your mind at any time, even after you have signed the form. Any procedure in addition to those described on this form will only be carried out if it is necessary to save life, or to prevent serious harm to your health or sight. I have been told about additional procedures above which may become necessary during my operation. I accept there are other potential complications and have listed below any further questions or procedures which I do not wish to be carried out without further discussion.

5 PATIENT CONSENT Patient details The above explanation has been read by/to me. The nature of my eye condition has been explained to me and the proposed treatment has been described. The risks, benefits, alternatives, and limitations of the treatment have been discussed with me. All my questions have been answered. I hereby authorise Mr Tanner to carry out: left right bilateral cataract surgery Inserting a: Monofocal lens Toric lens Multifocal lens Toric Multifocal lens Using the following anaesthesia Topical Subtenons General Patient s Signature..Date Confirmation of consent I have confirmed with the patient that he or she has no further questions and wishes the procedure to go ahead. Mr Vaughan Tanner.....Date..

6 / / 20 RIGHT LEFT CATARACT SURGERY ANAESTHETIC : GA. Sub-Tenon Topical 90 marked superior and inferior in anaesthetic room INCISION : Superior Temporal KERATOME : 1.8mm 2.2mm Biolon Provisc Healon Healon GV Viscoat Vision Blue I.C P.E. RHEXIS : Central/circular other PHACO : Divide/Conquer Chop Incision enlarged slightly IOL : BAG SULCUS AC Miochol Wound Closure: Hydration Nylon I.C CEF Iopidine 1% Shield Oftaquix Pad Complications/Comments: